Atilla Alpay

Comparing techniques for pterygium surgery

Purpose: To compare various techniques of pterygium surgery including bare sclera, intraoperative mitomycin C application, conjunctival flap reconstruction, and conjunctival autografting technique. Methods: This study is designed to compare 4 currently used techniques in order to determine the complication and recurrence rates after pterygium exision. Included in the study were 77 eyes from 60 patients. Bare sclera technique was used to treat 21 primary pterygia;mitomycin C was used to treat 20 (16 primary, 4 recurrent) pterygia;18 (17 primary, 1 recurrent) pterygia were treated by conjuntival flap reconstruction;and 18 (9 primary, 9 recurrent) pterygia were treated by conjunctival autografting technique. All patients who underwent surgery were followed up for between 6 months and 2 years. Results: Eight recurrences (38.09%) were observed in the bare sclera group whereas there were 5 (25%) recurrences in the mitomycin C group. In the conjunctival flap reconstruction group, 6 (33.33%) recurrences were detected. In the conjunctival autografting group, 3 recurrences were observed. There were no major complications threatening visual ability in the surgical patients. Conclusion: A comparison of the groups demonstrated that the recurrence rate was highest in the bare sclera group, and lowest in conjunctival autografting and mitomycin C treatment groups respectively. Although the conjunctival autografting technique is a more difficult and time consuming technique than the others, cosmetic and surgical results were found to be superior. We advise conjunctival autografting for the treatment of pterygium in view of the high recurrence rates of other techniques, and the possible complications of mitomycin C treatment for benign disease.

Unnoticed dysautonomic syndrome of the face: Harlequin syndrome

Harlequin sign and harlequin syndrome, which are used interchangeably in the literature, are characterized by sudden onset of hemifacial sweating and flushing, induced by exercise and heat. Hemifacial sweating and flushing with normal ocular sympathetic innervation, known as harlequin syndrome, is rarely associated with tonic pupils, parasympathetic oculomotor lesion and pre- or postganglionic sudomotor sympathetic deficit. In the literature, hemifacial sweating and flushing in patients with apparently abnormal ocular sympathetic innervation has been defined as harlequin sign. To date, a few reports of excessive hemifacial sweating and flushing in structural lesion have been documented. Herein, we report five patients with excessive hemifacial sweating and flushing, two of whom had a syrinx. In presenting the patients, we have attempted to distinguish harlequin syndrome from harlequin sign. With this in mind, Case 1 can be described as harlequin syndrome resembling Ross syndrome, Case 2 as harlequin syndrome with normal ocular sympathetic innervation, Case 3 as harlequin sign with congenital Horner syndrome, Case 4 as harlequin sign with sympathetic and parasympathetic denervation sensitivity, and Case 5 as harlequin syndrome associated with occult sympathetic denervation sensitivity. These cases are discussed together with a review of the literature.

The course of corneal and intraocular pressure changes during pregnancy

OBJECTIVE To determine concurrent changes in corneal thickness, intraocular pressure (IOP), and corneal topography measurements during normal pregnancy. DESIGN Prospective cohort study. PARTICIPANTS We studied 50 eyes from 25 healthy women whose ages ranged from 21 to 35 years and who were first seen during the 10th week of pregnancy. METHODS Measurements included IOP (noncontact tonometry); corneal thickness (ultrasound pachymetry); and corneal topography (TMS 2N, TOMEY, Nagoya, Japan). Changes in IOP, central corneal thickness (CCT), and corneal power were calculated at 4 time periods: first trimester, second trimester, third trimester, and 3 months postpartum. RESULTS The mean IOPs in the second and third trimesters of pregnancy were found to be lower than those in the first trimester and at 3 months postpartum (p = 0.001). The mean CCT in the second and third trimester of pregnancy was measured to be higher than in the first trimester and at 3 months postpartum (p < 0.001). Both IOP and CCT returned to first-trimester levels following delivery. In the third trimester, a 3.1% increase in CCT was associated with a 9.5 % decrease in IOP. Topographic measurements did not show statistically significant changes throughout the trimesters or after pregnancy. CONCLUSIONS An increase in CCT was accompanied by a decrease in IOP in the second and third trimesters. Physiologic changes occurring in CCT and IOP should be considered in the management of glaucoma during pregnancy.

Validation of plusoptiX S04 photoscreener as a vision screening tool in children with intellectual disability

PURPOSE Intellectual disability (ID) is a major public health issue, affecting more than 1% of children worldwide. Pediatric vision screening using standard eye charts may be challenging for children with ID, who may benefit from a quick noninvasive vision screening tool. This study evaluated the accuracy of plusoptiX S04 (Plusoptix Gmbh, Nuremberg, Germany) in detecting amblyopia risk factors in children with ID. METHODS Children diagnosed with ID according to age-appropriate psychological tests were examined consecutively. Vision screening was performed using the plusoptiX S04 prior to complete ophthalmological examination, including cycloplegic refraction. Pass/refer screening results was compared with findings of ophthalmological examination. Amblyogenic risk factors were defined according to American Association for Pediatric Ophthalmology and Strabismus referral criteria. RESULTS A total of 182 infants and children were examined. Only 3% of children were uncooperative for screening. Ophthalmological examination detected amblyogenic risk factors in 32% of patients. The sensitivity of plusoptiX S04 was 95% (95% CI, 85.6%-98.9%), and specificity was 50% (95% CI, 40.8%-59.1%). The positive predictive value was 47% (95% CI, 37.7%-56.4%) and the negative predictive value was 95.4% (95% CI, 87.1%-99.1%). CONCLUSIONS High sensitivity and negative predictive values suggest that the plusoptiX S04 will detect most children with ID who have amblyogenic risk factors, but one-half of all children referred will have no risk factors.

The local vasoconstriction of infant's skin following instillation of mydriatic eye drops

BackgroundSystemic absorption of eye drops is known to occur via the nasal mucosa, cornea, and conjunctiva. Diffusion of eye drops through the skin is previously unrecognized. Here, two cases are presented in which we observed skin pallor around the eyes after instillation of phenylephrine 2.5% drops. Case 1 A 32-week gestational age premature infant had mydriatic eye drops instilled as part of retinopathy of prematurity screening. Case 2 A term newborn dysmorphic infant underwent fundus examination to rule out ocular pathology. In both cases, discoloration of periorbital skin was observed 45 min following administration of drops.ConclusionThe risks of percutaneous toxicity must always be considered in children, especially in premature neonates, in whom the epidermal permeability barrier is frequently incompetent. Application of smaller drop size or wiping of overflowed drop from the skin may be useful to decrease the risk of systemic side effects.

Effects of a new hemostatic agent Ankaferd Blood Stopper® on the intraocular tissues in rat model

Purpose: To investigate the histopathological changes due to administration of Ankaferd Blood Stopper® (ABS) into intraocular tissues by an anterior chamber and intravitreal injections. Methods: Twenty Wistar albino rats were divided into four equal groups. Group 1 was injected 0.01 mL ABS into anterior chamber. Group 2 was injected intravitreal 0.02 mL ABS. Groups 3 and 4, which were used as controls, were injected into the anterior chamber and intravitreal 0.01 mL and 0.02 mL balanced salt solution (BSS), respectively. At 2, 5, 10, 15 and 20 days after injection, the eyes were examined under an operating microscope and were subsequently enucleated for histopathological examination. Results: Ophthalmic examination of the rats prior to enucleation revealed ocular complications ranging from conjunctival hyperemia to corneal perforation in group 1 and increased conjunctival hyperemia and discharge in group 2. No physical and histopathological anomalies were detected in groups 3 and 4. All eyes in group 1 showed mixed type inflammatory cell reaction, foreign-body reaction, stromal congestion, disintegration of the collagen fibers and loss of the epithelium of the posterior wall in the iris and ciliary body were observed histopathologically. All eyes in group 2 showed disintegration and separation of the retina, brown pigment accumulation and mixed type inflammatory cell reaction. Conclusion: Our results indicate that the commercially available form of ABS solution exerts a toxic effect on intraocular tissues. We consider that the intraocular use of different concentrations, rather than multiple time point of ABS should be investigated.

Effects of the folk medicinal plant extract Ankaferd Blood Stopper® on the ocular surface

Purpose: To investigate the effects of Ankaferd Blood Stopper® (ABS) on the ocular surface. Methods: Twenty adult male Wistar albino rats, weighing 390–530 g, were used in this prospective, controlled trial. One drop of ABS and one drop of balanced salt solution (BSS) were instilled into the lower conjunctival sac of the right and left eyes, respectively. After the rats were anesthetized, the ocular surface was evaluated based on the Draize criteria, and fluorescein tests were performed at 1, 2, 4, 18, 24, and 48 h. Subsequently, the rats were killed and all eyes were enucleated for histopathological examination. Results: The outcome of the Draize and fluorescein tests revealed that ABS caused more irritation of the ocular surface than BSS (P < 0.001). The highest mean ABS score was 4.9 for the Draize test and 0.4 for the fluorescein test, and ABS was considered to be a slight irritant. Histopathological examinations of the cornea and the conjunctiva revealed no significant difference between the eyes instilled with BSS and those instilled with ABS. Conclusions: ABS is a hemostatic drug that exerts a slight toxic effect on the ocular surface. Given its ease of use and antibacterial activity, as well as its efficiency in stopping bleeding, the use of ABS during ocular surgery should be further investigated in experimental and clinical studies.

Color Doppler Evaluation of the Retrobulbar Hemodynamic Changes in Chronic Obstructive Pulmonary Disease: COPD and Retrobulbar Hemodynamic Changes.

The aim of this study was to evaluate the hemodynamic changes in the extraocular orbital vessels of the patients with chronic obstructive pulmonary disease (COPD), using color Doppler ultrasonography, and to compare the results with those of healthy control subjects. The control group consisted of 35 healthy subjects who had no systemic problems, while the study group consisted of 60 patients with the diagnosis of COPD. Patients with COPD were grouped according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD). Twenty patients of stage 1 COPD (mild airflow limitation), stage 2 COPD (moderate airflow limitation), or stage 3 COPD (severe airflow limitation) were included in the groups 1, 2, and 3, respectively. Measurements were performed in both eyes of each participant. Peak systolic velocity (PSV), end-diastolic velocity (EDV), resistance index (RI), and pulsatility index (PI) were measured in the ophthalmic artery (OA), central retinal artery (CRA), and posterior ciliary artery (PCA). The RI and PI measurements of the OA, CRA, and PCA were significantly higher in group 3 when compared to the control group and groups 1 and 2. These significances were not observed when PSV and EDV values were compared. There were also no significant differences between groups 1, 2, and control patients, when mean PSV, EDV, RI, and PI values of all arteries were compared. None of the above parameters showed statistical significance when mean RI, PI, PSV, and EDV were compared between left and right eyes. Severe (stage 3) COPD is associated with impaired retrobulbar hemodynamics. Increased hypoxia and vascular mediators may be suggested in etiology.

Tear function and ocular surface after Muller muscle-conjunctival resection.

Muller muscle-conjunctival resection (MCR) is a surgical technique to correct mild and moderate ptosis. In this study, tear function tests and ocular surface are evaluated in patients who underwent unilateral surgery. Sixteen patients with normal preoperative tear function who underwent unilateral MCR were evaluated prospectively. The fellow eyes of the patients were taken as the control group. A dry eye assessment questionnaire, Schirmer testing, tear film break-up time, fluorescein stain, Rose-Bengal stain, and conjunctival impression cytology were used to assess the tear film functions and ocular surface changes in the operated and non-operated eyes. There was no statistically significant difference in the tear function tests and goblet cell densities between the operated and non-operated eyes. The results indicate that an MCR procedure has no apparent effect on tear function tests and goblet cell density in patients with normal preoperative tear function.

Use of a novel haemostatic agent: ankaferd blood stopper in conjunctival incisions

Background:  To investigate the haemostatic efficacy and histopathological effects of a new haemostatic agent, ankaferd blood stopper, in a rat conjunctival incision model.